I just got my 2014 brochure, the one with the New! Improved! benefits (and commensurate New! Improved! premium, of course). Having spent a fair chunk of this year dealing up close and personal with a beloved family member’s cancer treatment, I naturally turned to the oncology section first.
Ah, here it is: Sub-limit = R500 000 per family. Limited to 1 x PET scan per annum for ’staging’ and subject to annual Specialised Radiology benefit.
For those who’ve never had to deal with cancer, staging is the process whereby they check if the cancer has developed and spread, or alternatively, if it’s been checked and shrunk. Obviously you need a base scan at the start of treatment, so that you have something with which to compare the scan you have when the treatment ends.
So my first thought: sounds big, that R500 000, doesn’t it. Well, I’ve been reading Campaigning for Cancer’s presentation on this subject, and I’m here to tell you it ain’t.
First of all, it’s per family. Let’s say a ten-year-old, Bruce Jones, was diagnosed with leukaemia in October this year. And then let’s imagine this is a very unlucky family (and given my own family experience with health issues this year, this no longer sounds like a crazy scenario to me): mom is diagnosed with breast cancer at the end of January 2014.
Now little Bruce is still needing intensive treatment in the early part of the year, but Sally’s about to embark on a long and rough ride herself. R500 000 may fall very, very short indeed, capisce?
Plus there are some sub-clauses to watch out for in that brochure. There’s a limit of R200 000 imposed for biological entities. Now Herceptin, the treatment of choice for some kinds of breast cancer, is a biological entity.
And it can cost R25 000 a time – some patients are required to have 16 shots a year. 16 x R25 000 – yup, that’s right, little Johnny at the back of the classroom, that’s R400 000 (even a lower number of shots can exceed the limit easily).
So Sally could have to find R200 000 on her own – plus the R20 000 levy this medical aid would charge on the R200 000 it does cover.
Not only are you not allowed more than one PET scan, you’re limited as to other scans, too. MRI and CT scans attract a R1 500 co-payment – and you’re limited to a total of R12 600 per family. Does that sound like a lot to you?
Bwahahaha! My dear little innocent-abroad, one single MRI scan can gouge anything from R6 000 to R12 000 out of you (depending on what they scan, whether they use contrast dyes, rhubarb rhubarb fishpaste).
And let me just point out that the cancer journey has many twists and turns – whatever they tell you at the outset, you may be blindsided by an unexpected reaction to your treatment or such-like and really need an MRI.
And if you can’t have that second PET scan, you’ll want to use a CT scan (about R5 000) to at least get some idea of where you’re at.
Just with the mastectomy and the Herceptin, the Jones’ family’s oncology limit is blown. All extras will need to be paid for – even on the most positive journey to remission, you’ll might have to find somewhere between R50 000 and R150 000 extra in your annus horribilis.
But now imagine a not-so-smooth journey. Let’s picture a scenario where Sally is NOT clear of cancer at the end of her treatment. It’s spread. This much-loved mom and wife is probably going to die. Soon she’ll need palliative care: pain relief, nursing care, plus some psychological caring.
Will the medical aid pay for the things that help to make her last days bearable? Well, Campaigning for Cancer says probably not: it’ll be deemed to be ‘frail care’ and not covered.
Llewellyn Jones, a man in agony as he faces the loss of his soul mate, will probably spend hours in the office of his bank manager, trying to negotiate a way of paying for Sally’s care.
Campaigning for Cancer is currently running a campaign (cards on the table: I know about it because I’m writing some articles for the NGO) to spur thoughts about how to ensure all South Africans have access to oncology.
If you imagine that the only people in South Africa to whom this applies are those reliant on the state system, re-read what I’ve written here, go and check your own medical aid’s wording, and think again.
There are only 16% of us on medical aid, and we all tend to think we’re the lucky ones; we may have to make huge co-payments on our GP consults and dental care, but when the chips are down and a crisis hits, we’re alright, Jack – right? Not!
If you have any ideas about how we should, as a community, be handling this, about what we can do to change the way things work so that people in a time of crisis don’t have to spend hours scrabbling for funds, begging for split payments or making decisions that they shouldn’t have to, decisions that accept compromised care because ‘the money’s just not there’; then go look on Twitter for the handle @campaign4cancer and add your two cents worth.
*Mandi Smallhorne is a versatile journalist and editor. Views expressed are her own.